28 Evaluating the Impact of Best Practice Advisories and Order Set Usage on Sepsis Patient Outcomes

Abstract

Sepsis is a clinical syndrome with physiologic, pathologic, and biochemical abnormalities which are induced by underlying infection. Early recognition and treatment improve patient outcomes. Best practice advisories (BPAs) have been developed to facilitate early recognition of sepsis. The BPA works by identifying patients with early potential sepsis indicators, prompting early physician evaluation. Sepsis order sets, which bundle antibiotics with lab orders as required by CMS Sepsis Management Guidelines, have also been created. We sought to assess the patient survival benefit of sepsis order set use when used independently as well as in conjunction with best practice advisory. A one-year retrospective chart review was conducted for patients diagnosed with sepsis, severe sepsis, or septic shock. Patient mortality was evaluated across four groups: BPA only, sepsis order set only, both BPA and sepsis order set, and neither BPA nor sepsis order set. Patients who survived were compared to those who did not survive with respect to demographics, comorbidities, and other important characteristics. Normally distributed continuous variables are presented as mean and standard deviation and p-values were obtained using t-tests. Non-normally distributed continuous variables are described using medians and quartiles and p-values obtained from Wilcoxon rank sum tests. There were 11,573 patients diagnosed with sepsis, septic shock or severe sepsis during the study period. Of these, 1279 patients did not survive to discharge. After controlling for variables that significantly impact mortality, BPA and order set use significantly lowered mortality rate. Those patients who had both BPA and order set used were 56% more likely to survive as compared to those who did not have BPA and order set use (p <0.0001). Mortality rate among patients who had BPA only or order set use only were not significantly different from those who had neither BPA nor order set use, p-values 0.5007 and 0.9918 respectively. When BPAs and sepsis order sets are used in conjunction, there appears to be a significant decrease in patient mortality across severity of disease. This is likely because combination use of these tools allows early identification and treatment of sepsis which is critical to improved survival outcomes.